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An Introduction to Phobias
Phobias occur in several forms. A specific phobia is a fear
of a particular object or situation. Social phobia is a fear
of being painfully embarrassed in a social setting. And agoraphobia,
which often accompanies panic disorder, is a fear of being in
any situation that might provoke a panic attack, or from which
escape might be difficult if one occurred.
Specific Phobias
-- "I'm scared to death of flying, and I never do
it anymore. It's an awful feeling when that airplane door
closes and I feel trapped. My heart pounds and I sweat
bullets. If somebody starts talking to me, I get very
stiff and preoccupied. When the airplane starts to ascend,
it just reinforces that feeling that I can't get out.
I picture myself losing control, freaking out, climbing
the walls, but of course I never do. I'm not afraid of
crashing or hitting turbulence. It's just that feeling
of being trapped. Whenever I've thought about changing
jobs, I've had to think, "Would I be under pressure
to fly?" These days I only go places where I can
drive or take a train. My friends always point out that
I couldn't get off a train traveling at high speeds either,
so why don't trains bother me? I just tell them it isn't
a rational fear."
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Phobias aren't just extreme fear;
they are irrational fear. You may be
able to ski the world's tallest
mountains with ease but feel panic
going above the 10th floor of an
office building
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Many people experience specific phobias, intense, irrational
fears of certain things or situations--dogs, closed-in places,
heights, escalators, tunnels, highway driving, water, flying,
and injuries involving blood are a few of the more common ones.
Phobias aren't just extreme fear; they are irrational fear.
You may be able to ski the world's tallest mountains with ease
but panic going above the 10th floor of an office building.
Adults with phobias realize their fears are irrational, but
often facing, or even thinking about facing, the feared object
or situation brings on a panic attack or severe anxiety.
Specific phobias strike more than 1 in 10 people. No one knows
just what causes them, though they seem to run in families and
are a little more prevalent in women. Phobias usually first
appear in adolescence or adulthood. They start suddenly and
tend to be more persistent than childhood phobias; only about
20 percent of adult phobias vanish on their own. When children
have specific phobias--for example, a fear of animals--those
fears usually disappear over time, though they may continue
into adulthood. No one knows why they hang on in some people
and disappear in others.
If the object of the fear is easy to avoid, people with phobias
may not feel the need to seek treatment. Sometimes, though,
they may make important career or personal decisions to avoid
a phobic situation.
When phobias interfere with a person's life, treatment can
help. Successful treatment usually involves a kind of cognitive-behavioral
therapy called desensitization or exposure therapy, in which
patients are gradually exposed to what frightens them until
the fear begins to fade. Three-fourths of patients benefit significantly
from this type of treatment. Relaxation and breathing exercises
also help reduce anxiety symptoms.
There is currently no proven drug treatment for specific phobias,
but sometimes certain medications may be prescribed to help
reduce anxiety symptoms before someone faces a phobic situation.
Social Phobia
-- "I couldn't go on dates or to parties. For a while,
I couldn't even go to class. My sophomore year of college I
had to come home for a semester."
"My fear would happen in any social situation. I would
be anxious before I even left the house, and it would escalate
as I got closer to class, a party, or whatever. I would feel
sick to my stomach--it almost felt like I had the flu. My heart
would pound, my palms would get sweaty, and I would get this
feeling of being removed from myself and from everybody else."
"When I would walk into a room full of people, I'd turn
red and it would feel like everybody's eyes were on me. I was
too embarrassed to stand off in a corner by myself, but I couldn't
think of anything to say to anybody. I felt so clumsy, I couldn't
wait to get out."
Social phobia is an intense fear of becoming humiliated in
social situations, specifically of embarrassing yourself in
front of other people. It often runs in families and may be
accompanied by depression or alcoholism. Social phobia often
begins around early adolescence or even younger."
If you suffer from social phobia, you tend to think that other
people are very competent in public and that you are not. Small
mistakes you make may seem to you much more exaggerated than
they really are. Blushing itself may seem painfully embarrassing,
and you feel as though all eyes are focused on you. You may
be afraid of being with people other than those closest to you.
Or your fear may be more specific, such as feeling anxious about
giving a speech, talking to a boss or other authority figure,
or dating. The most common social phobia is a fear of public
speaking. Sometimes social phobia involves a general fear of
social situations such as parties. More rarely it may involve
a fear of using a public restroom, eating out, talking on the
phone, or writing in the presence of other people, such as when
signing a check.
Although this disorder is often thought of as shyness, the
two are not the same. Shy people can be very uneasy around others,
but they don't experience the extreme anxiety in anticipating
a social situation, and they don't necessarily avoid circumstances
that make them feel self-conscious. In contrast, people with
social phobia aren't necessarily shy at all. They can be completely
at ease with people most of the time, but particular situations,
such as walking down an aisle in public or making a speech,
can give them intense anxiety. Social phobia disrupts normal
life, interfering with career or social relationships. For example,
a worker can turn down a job promotion because he can't give
public presentations. The dread of a social event can begin
weeks in advance, and symptoms can be quite debilitating.
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People with social phobia aren't
necessarily shy at all. They can be
completely at ease with people most
of the time, but in particular
situations, they feel intense anxiety.
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People with social phobia are aware that their feelings are
irrational. Still, they experience a great deal of dread before
facing the feared situation, and they may go out of their way
to avoid it. Even if they manage to confront what they fear,
they usually feel very anxious beforehand and are intensely
uncomfortable throughout. Afterwards, the unpleasant feelings
may linger, as they worry about how they may have been judged
or what others may have thought or observed about them.
About 80 percent of people who suffer from social phobia find
relief from their symptoms when treated with cognitive-behavioral
therapy or medications or a combination of the two. Therapy
may involve learning to view social events differently; being
exposed to a seemingly threatening social situation in such
a way that it becomes easier to face; and learning anxiety-reducing
techniques, social skills, and relaxation techniques.
The medications that have proven effective include
antidepressants called MAO inhibitors. People with a specific
form of social phobia called performance phobia have been helped
by drugs called beta-blockers. For example, musicians or others
with this anxiety may be prescribed a beta-blocker for use on
the day of a performance.
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-excerpted from the National Institutes of Health, Publication
97-3879
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